Imperative hallucinations

Auditory or as they are called imperative hallucinations. Experts more often than others have to meet with this kind of complaints. The sounds and noises that the patient hears are quite diverse. These can be jerky fuzzy sounds or distinct whole phrases, a clatter, a scratching sound, a lonely voice or a cacophony of voices. The level of noise in the head can be slightly distinguishable or very loud, unfamiliar or familiar. Most often these sounds scare the patient. They threaten him, promising to punish; frighten; subordinating themselves, are forced to carry out their orders. Such psychological pressure morally breaks the "victim". He begins unconditionally to execute the commands that sound in his head.

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Causes of imperative hallucinations

In "banal" neuroses, auditory delirium usually does not manifest itself. Therefore, the appearance of hallucinations in a person speaks of major changes that affect individual parts of the human brain. Analyzing the clinical picture in each individual case, a qualified doctor tries to determine the source, which became the catalyst of the disease.

To date, doctors have called only a few reasons for imperative hallucinations, but some of them remain beyond human understanding.

Alcoholism. Persons suffering from this disease (especially for a long time) are quite susceptible to auditory hallucinations. They are expressed in the appearance in the head of an alcoholic voice, which appeals to him, calling for a conversation. But most often, there are several voices, they communicate with each other, "discussing the patient, commenting on his actions," causing the patient panic. Against the backdrop of such a disorder of the psyche, it is almost impossible to foresee the further actions of such a person.

Schizophrenia is a psychotic personality disorder. The auditory transformation in this case is directed directly to the patient. The voice communicates with him, gives orders.

These are the most common sources. But there are many more. For example, such a symptomatology can provoke and venereal diseases, for example, syphilis.

Suffers from the strongest auditory cacophony and people who use drugs.

The body grows old, pathological changes take place that can lead to the development of senile paranoia, which is also capable of causing the victim such a symptom.

In the list of the root causes of the emergence of imperative hallucinations, it should be noted and amenu - a very severe form of obscuration of consciousness, expressed in the negative transformation of speech production of sound, "distortion" of thinking and perception of the world. The whole danger of this disease lies in the fact that such a multifaceted distortion is quite capable of leading a patient to death.

Imperative hallucinations physicians refer to deviations of a verbal nature.

Having established the cause of pathological changes, a qualified doctor can predict the outcome of treatment therapy.

[3], [4], [5]

Symptoms of imperative hallucinations

From Latin, imperatum is translated as order, therefore the terminology in question refers to pathological auditory sounds that are perceived by the patient as orders that cause him to perform an action. The most common symptoms of imperative hallucinations are expressed in the receipt of patients with such orders, which are of a criminal and sadistic color, making the patient dangerous both to himself and to the people around him. The voice addresses directly to the person, giving commands: "take an ax, cut off your hand ...", "climb the window, jump ...", "take a rope and put a demon around your neck ..."

Not yet completely lost the whole sanity of the patient share with the doctor their fears. They are very afraid that at the next bout of voice they will order him to cause physical harm to one of his close people. After all, during an attack, a person loses control over his brain, the will is suppressed so much that he can not resist voices - it does not even occur to him.

Mostly the voice refers directly to the patient, but he does not call the patient by name. Quite rarely, vocal orders refer to abstract or long-term actions, usually such orders affect the situation "here and now".

Mostly the patient hears such whispers with both ears, but there are cases when sound perception comes from one side. Mostly people begin to hear voices at night, against the background of absolute silence.

A very similar pattern occurs when a patient is under hypnosis, in a state of deep trance.

Diagnosis of imperative hallucinations

If there are suspicions among surrounding and close people that a nearby person is suffering from the pathology considered in this article, a qualified psychiatrist should be consulted.

His diagnosis of imperative hallucinations usually begins with the fact that he makes sure that the patient suffers precisely on pathology, and not his conversations and stories are an illusion or a mere fantasy.

After auditory naveivanie - it's sound structures that arise in the minds of a sick patient in the absence of an external stimulus. People who have this pathology in the anamnesis are different from "dreamers" in that the latter can easily be changed to the contrary. While the psychiatrist's patients are not convinced by the unreality of the sound cacophony, it is unrealistic.

If a person under the influence of light effect or other factors sees how the wardrobe changes, turning into an angry bear, then this is an illusion, a mirage in the desert is an illusion. But if a person is convinced of the presence of a cat in an empty corner, then it is a hallucination. Similar tests are also available for identifying imperative hallucinations.

An important method of diagnosing the disease is visual observation by specialists for the behavior of the patient. Such monitoring allows the doctor to confirm the disease and determine its form of manifestation.

Pathological seizures can occur sporadically, with severe forms of mental disorder a person can completely immerse themselves in this state. It is very important not to allow such a transition.

The psychiatrist very closely supervises and change of a facial expression, as at the sick person the emotional displays expressed by change of a facial mimicry, are not commensurate with a surrounding situation. For example, against the background of full sorrow, such a patient is able to enjoy life, laugh ... Or against a background of complete tranquility, for example, a sunny morning, birds sing, and the patient is in a state of panic, fear, anger ...

The most pronounced symptom of auditory hallucinations is the patient's desire to plug his ears, hide his head under the pillow, so as not to hear his aching and frightening whisper. Thus the environment does not give preconditions to such actions.

There were recorded cases when sick people in horror, covering their ears with their hands, rushed headlong to the end, not dismantling the road, falling at the same time under the cars, falling out of the windows. Predominantly, such manifestations are rarely observed isolated, more often still there are complex changes in which auditory pathology is combined with other symptoms, for example, delusional conditions.

There are also healthy people exposed to illusions, whereas the appearance of hallucinating sounds is an indisputable indicator of mental pathology, which requires urgent emergency medical care.

Greater attention to your close relatives and friends will allow you to recognize the disease in time, because a person getting into such a situation, afraid of being misunderstood and stopped by the fear of being placed in a psychiatric hospital (or for some single known reason) tries to hide the delusional state, dissimulate it to his everyday life.

The hallucinating person becomes more alert, focused, constantly being on guard, not to betray his state. But when the early stage of the disease progression is missed, a person gradually begins to communicate with his imaginary interlocutor, answering his questions aloud.

[6], [7], [8]

Treatment of imperative hallucinations

If a person for the first time encounters such a pathological situation - it puts him into a stupor and horror. But we must remember the main thing - what happens, for a hallucinating person is a manifestation of his reality. Therefore, the first thing to remember for his close relatives is how to properly behave in this situation and what kind of help they can provide to their neighbor.

1. Under no circumstances should we even try to dissuade the patient that everything that happens to him is a reality transformed by the psyche.
2. It is necessary to show tact, patience, and in many ways and to show imagination, in order, first of all, to calm an excited and shocked person. For example, if he is absolutely sure that werewolves try to penetrate into the window at night, do not laugh, just take an active part in finding the means and ways to physically protect yourself from the threat (bring an aspen branch from the street, put an icon in the room, give a cross and so on).
3. It is necessary to take advantage of such attributes and try to create an atmosphere and an environment such that the resulting hallucinations do not cause such horror, that is, if possible mitigate the emotional severity and negative color.

At the same time, what is strictly forbidden to do to others, is:

• To make fun of the "sufferer".
• Show your irritation and discontent when the patient begins to show any fears. Rejoice that a loved one is trusting and seeking help, otherwise, he will simply close in himself, trying to contain the growing inner horror. But such a situation can not last forever, the moment will come when "an explosion" will occur, and even an experienced psychiatrist can not foresee this attack.
• Throw a hopeless lesson to convince the hallucinating that it is the fruit of his inflamed consciousness.
• Do not stress your and his attention on this issue and try to find out who is talking to him, what is the sound source.
• During an attack, it is especially necessary to monitor your emotions, do not raise your voice and talk too loud. During this period it is necessary for the patient to create the illusion that others are doing everything to help him and "save him."
• Somewhat reduce the excitement can calm calming music, a change of scenery, in special cases, medicinal medicines, which should be prescribed only by a graduate.

But as if relatives were not attentive to the "victim", he just needs qualified medical care. Having addressed to the expert, the diagnosis will be made, recommendations are given and adequate therapy is appointed.

To date, the treatment of imperative hallucinations is carried out by several methods, but all of them, mainly, are aimed at eliminating pathological attacks, the patient's withdrawal from the delusional state.

The protocol of treatment therapy usually includes such pharmacological drugs as tizercin, chlorazine, kontomin, plegomazin, gibanil, torazin, chlorpromazine hydrochloride, aminazine, largocityl, chlorpromazine, phenactyl, ampliactyl, hibernal, promactyl, propafenin, megaphene, cloproman or amplithyl.

An antipsychotic, neuroleptic drug, aminazine, is usually administered intramuscularly or intravenously.

In case of intramuscular injection, the single maximum dosage is 0.15 g, for a day - 0.6 g. The recommended intake schedule is usually represented by the appointment of one to five milliliters of a 2.5% solution, but not more than three procedures throughout the day.

In case of an acute attack of the disease, the doctor prescribes intravenous administration of the drug. At the same time, two to three milliliters of 2.5% solution are diluted with 20 ml of a 40% solution of glucose before injection. With this method of drug delivery into the body, a single maximum dosage is 0.1 g, within a day - 0.25 g.

When stopping the attack at home, the psychiatrist can prescribe the drugs of this group in the form of tablets or dragees. Aminazin is taken orally immediately after meals (this will reduce the level of irritation of the mucous organs of the digestive tract). The starting daily dosage of the drug is 25 to 75 mg, separated by one to two to three doses.

Contraindications to the use in the protocol of treatment of this drug are:

• Individual intolerance to the patient's body of one or more constituent components of the drug.
• And also the presence of an anamnesis of cardiovascular decompensation.
• Ulcerous and erosive lesions of the stomach and duodenum.
• Serious pathological changes in the liver and kidneys.
• Severe hypotension.
• Faults in the work of the stomach.

In parallel, the doctor also appoints haloperidol, Senorm, haloper, trancodol-5 or trisedil.

A neuroleptic belonging to derivatives of butyrofenone, haloperidol is administered to the patient orally 30 minutes before the intended meal. To reduce the level of irritation of the mucosa of the digestive system, the drug can be drunk with a sufficient amount of milk.

The starting daily recommended dosage (depending on the clinical picture and intensity of the attack) is prescribed in the range of 0.5 to 5 mg, separated by two to three doses. Gradually, the dosage increases by 0.5 - 2 mg, until the time when the expected therapeutic effect is achieved. In especially severe cases, the dosage increment can be from 2 to 4 mg.

The maximum allowable amount of a drug that is allowed in a daily intake is determined by the figure of 100 mg.

In most cases, the therapeutic efficacy of relieving the attack can be achieved at daily dosages of 10-15 mg.

If the patient has a chronic form of schizophrenia, then the problem is usually cured by daily dosages of 20-40 mg.

In resistant cases, with a special immunity of the patient's body to the drug, the quantitative component of its administration may stop at 50-60 mg.

The maintenance dosage, which is taken by the patient between the seizures, is 0.5 to 5 mg per day. These figures are reduced very carefully and gradually.

The duration of therapy can take an average of two to three months.

If the disease is diagnosed in children from 3 to 12 years old, whose body weight falls within the limits of 15 to 40 kg, the dose of the drug to be administered is calculated from 0.025 to 0.05 mg per kilogram of the weight of a small patient, separated by two to three doses. Increase dosage can be no more than once every five to seven days. The maximum allowable daily intake of the drug should not exceed a figure of 0.15 mg per kilogram of the patient's weight.

For elderly people suffering from imperative hallucinations, the amount of medication administered is reduced and half or even a third of the recommended adult dose is administered. The dosage can be increased no more often than once every two to three days.

If necessary, the attending physician may prescribe this drug in another release form: oral drops, solution for intravenous or intramuscular injections.

It is not recommended to use the drug in the treatment protocol if the patient suffers Parkinson's disease, central nervous system depression, basal ganglia infection, with depressive disorders and if the patient's age is less than three years, as well as when the patient's body shows hypersensitivity to the drugs ingredients and derivatives of butyrophenone.

Other antipsychotic and atypical antipsychotic drugs, as well as the necessary antidepressants, may also be included in the protocol of therapy.

For example, it can be moclobemide (aurorix), imipramine (melipramine), bebol, citalopram (tsipramil), amitriptyline, simbalta (duloxetine), trimipramine (gerfallal) and many others.

Antidepressant and sedative - amitriptyline - is given to the patient for oral intake, without chewing, immediately after a meal - this will reduce irritation of the mucosa of the digestive tract.

The drug is taken in several ways: just before bedtime, the maximum dose is administered. For an adult patient, this dosage is 25 to 50 mg. Gradually small amounts increase the initial figure to 150-200 mg per diem, divided into three doses, while the time for which this increase is made, from five to six days.

If for two weeks the therapeutic effect is not visible, the daily amount of the drug administered is increased to 300 mg. If the depressive symptoms disappeared, the prescribed amount of the drug, on the contrary, is gradually reduced to the figures 50-100 mg per day.

The duration of treatment is an average of at least three months.

To elderly people, with mild disorder, dosages falling within the limit of 30 to 100 mg daily are attributed, and after achieving therapeutic efficacy, the administered amount of the drug is reduced to a daily 25-50 mg.

If necessary, the use of other forms of release of the drug in question is allowed.

Amitriptyline can be administered in the form of a solution intravenously or intramuscularly. The rate of drug delivery is slow. The starting amount is 20 - 40 mg four times a day. Injections are gradually replaced by a tablet form of administration.

The duration of the treatment course is no more than six to eight months.

The dosage for children from six to twelve is 10-30 mg, or is calculated as 1-5 mg per day per kilogram of the weight of a small patient, divided into several receptions.

For adolescents over 12 years - 10 mg three times during the day. In case of medical necessity, the amount of medication administered can be increased to 100 mg per day.

Contraindication to use is the acute phase or recovery period after a heart attack, closed angle glaucoma, acute alcohol poisoning, the presence of intraventricular conduction in the patient, simultaneous treatment with MAO inhibitors, as well as increased sensitivity to the components of the drug and amitriptyline.

Any hallucinations, including auditory ones, are treated according to a strictly individual scheme, because the source of pathological deviations in each person can be different and consists of many different factors.

If it turns out that the cause of abnormal noise is a malfunction of the hearing aid, then, naturally, you should contact the audiologist, check the device and, if necessary, replace it with a working one.

Prevention of imperative hallucinations

Something specific to advise and give advice in this situation is quite difficult. The only thing that can be attributed to the subsection "prevention of imperative hallucinations" - these are a few tips:

• Adhere to a healthy lifestyle.
• Learn to avoid stressful situations.
• Avoid strong physical and mental stress, exhaustion.
• Refuse bad habits, especially those associated with hallucinogens.

It is not strange, but such simple advice will several times reduce the risk of developing a lesion, called in medicine by imperative hallucinations.

Forecast of imperative hallucinations

If during the development of a mental illness, hallucinations join the pathological symptomatology, physicians state the deterioration of the patient's condition and the complication of the clinical picture of the disease. The auditory hallucinations sounding in the ears of a sick person as an order are called imperative. Quite often, audible voices are of a criminal - sadistic color, prompting for action, which is dangerous either for the person himself or for his associates. If you do not take timely measures and do not follow the patient on maintenance therapy, the prognosis of imperative hallucinations is very deplorable.

If the measures are taken late or the symptoms have been ignored, then for the patient everything can end in a lethal outcome. Often the disease in question is observed in people prone to suicidal or homicidal actions.

Even a healthy person, hearing a whisper and not finding his source, is not comfortable feeling the seed in this situation, and what to say about the sick person. Auditory deceptive sensations, which have an aggressive imperative character - imperative hallucinations - are quite a serious and dangerous disease, which can only be managed by a highly qualified specialist. Therefore, if you have any doubts about your account or at the expense of your loved one, it is better to consult a doctor. The main thing is not to miss the onset of the disorder, when it can still be controlled with fairly sparing medicines. Such a patient, on the background of drug therapy, is able to lead a sufficiently high-quality social life. But if the moment is missed and the disease progresses - it is necessary to treat the disease, but now it will be necessary to apply much more strength and patience, and the result is quite difficult to predict.

So be attentive to yourself and your family and friends!